Provider Demographics
NPI:1821080037
Name:NORMAN, GERALD PAUL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:PAUL
Last Name:NORMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-5332
Mailing Address - Country:US
Mailing Address - Phone:936-560-2708
Mailing Address - Fax:
Practice Address - Street 1:685 7TH ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:TX
Practice Address - Zip Code:75760
Practice Address - Country:US
Practice Address - Phone:936-326-8500
Practice Address - Fax:936-326-8502
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02176363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P06776Medicare UPIN